Tülin AYAZOĞLU AKARSU, Hülya TÜR, Cihan BOLAT

Koroner arter by-pass greftleme haricindeki kalp hastalarında apache II mortalite tahmininde etkili midir?

Amaç: Yoğun bakım ünitesi (YBÜ)’nde izlediğimiz Koroner Arter By-Pass Greftleme (KABG) operasyonu geçiren hastalar dışındaki kardiyak sorunu olan olgularda “Acute Physiology and Chronic Health Evaluation (APACHE) II” skorlamasının başarılı olup olmadığını saptamaktır. Materyal ve Metot: KABG operasyonu geçirmiş hasta haricinde, entübasyon ve mekanik ventilasyon gerekliliği ile YBÜ'ye kabul edilen, kardiyak sorunu olan, ardışık 118 erişkin olgunun prospektif olarak toplanan verileri analiz edildi. İlk 24 saatteki en kötü fizyolojik verilere göre APACHE II skoru hesaplandı. APACHE II sistemine göre düzeltilmiş beklenen mortalite hızları saptandı. YBÜ’de gözlediğimiz mortalite hızı kaydedildi. Bulgular: Olguların (78 erkek/40 kadın) yaş ortalaması 63,3±16 yıl idi. Olguların:APACHE II skoru ortalaması 21,85±4,05, APACHE II skoruna göre tahmini yoğun bakım kalış süresi ortalaması 5,85±0,84 gün, APACHE II skoruna göre tahmini ölüm oranı ortalaması %49±%15 idi. YBÜ’de gözlenen mortalite hızı %66, beklenen mortalite hızı ise %48 idi. Beklenen mortalite hızı ile yoğun bakım mortalitesi benzerlik göstermedi. Sonuç: Bu çalışmada APACHE II performansının yetersiz olduğunu, hastalığa spesifik olan skorlama sistemlerinin tercih edilmesi gerektiği kanısına vardık.

Is APACHE II score useful in predicting mortality in patients with cardiac disorders who have not undergone CABG?

Aim: To compare observed and predicted mortality rates with Acute Physiology and Chronic Health Evaluation (APACHE) II scores in patients with cardiac problems who has not undergone CABG. Material and Methods: Prospectively collected data of 118 adult patients were analized in patients who were admitted to the intensive care unit for tracheal intubation and mechanical ventilation. The worst values of the physiological data in the first ICU-day were used for the calculations of APACHE II scores. Adjusted predicted mortality rate according to APACHE II scoring system was determined. Observed mortality rate in the ICU was recorded. Results: Mean age of cases (78 male/40 female) was 63,3±16 (19-87) years. Mean APACHE II score was found to be 21,85±4,05. The average length of stay in the intensive care unit was 5.85±0.84 (3.9 to 8) days. Observed ICU mortality rate and the expected mortality rate was 66% and 48%, respectively (p<0,05) and the difference was statistically significant. Expected mortality rate did not show similarities with the intensive care unit mortality. Conclusion: In this study we concluded that the performance of APACHE II was inadequate and disease specific scoring systems should be preferred.

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